More frequent glycemic abnormalities and higher mortality occurred in patients with severe acute respiratory syndrome (SARS) due to COVID-19 vs patients with SARS due to other causes, according to study findings published in BMC Pulmonary Medicine.
In patients with SARS related to COVID-19, dysglycemias frequently develops and is linked to worse outcomes, but the extent of dysglycemias in other SARS-related conditions is unknown. Investigators therefore sought to compare the incidence of glycemic abnormalities in patients receiving critical care due to COVID-19-related SARS vs patients with SARS due to other causes. Researchers also evaluated associations between dysglycemias, COVID-19, and mortality within 30 days of intensive care unit (ICU) admission.
The primary outcome of interest was the effect of COVID-19 on multiple parameters of dysglycemia, including: glucose level at admission, glucose levels during the ICU stay, glucose variability, days with hyperglycemia, and hypoglycemia during the ICU stay.
This retrospective cohort study, conducted from mid-March 2020 to mid-September 2020 in 8 hospitals in Curitiba, Brazil, included 841 consecutive adult patients (mean [SD] age, 61 [16.6] years) admitted to the ICU with SARS and suspected COVID-19. After testing to confirm or refute suspected COVID-19, it was found that 703 patients had COVID-19 (57% women, 32% presumed obesity) and 138 patients did not have COVID-19 (50% women, 17% presumed obesity).
The dysglycemias were not independently associated with COVID-19, but rather related to disease severity, inflammatory markers, and the use of glucocorticoids.
In the non-COVID-19 group, SARS was related to exacerbated chronic pneumopathies in 15% of patients, cardiovascular diseases in 18% of patients, and pneumonia in 54% of patients. Patients in the COVID-19 group had higher C-reactive protein values, higher incidence of nosocomial infection, higher mean Sequential Organ Failure Assessment (SOFA) scores, and higher need for invasive mechanical ventilation and vasoactive medications during their ICU stay compared with those in the non-COVID-19 group.
Upon admission, patients with COVID-19 had significantly higher peak glucose (165mg/dL vs 146mg/dL; P =.002). During the ICU stay, patients with COVID-19 vs without COVID-19 also had higher peak glucose (242mg/dL vs 187mg/dL; P <.001); a higher percentage of days with hyperglycemia (42.9% vs 11.1%; P <.001); greater mean glucose variability (28.1mg/dL vs 25.0mg/dL; P =.013); and higher mean daily glucose (149.7mg/dL vs 132.6mg/dL; P <.001). Notably, after adjustment for corticosteroid use, C-reactive protein level, SOFA scores, Acute Physiology and Chronic Health Evaluation II scores, and nosocomial infection, there was no longer statistical significance to these associations. The investigators further found that during the ICU stay, the occurrence of hypoglycemia (<70mg/dL) was not associated with COVID-19.
The investigators noted that their findings indicate that “the dysglycemia in patients with COVID-19 was not directly associated with the SARS-CoV-2 infection as previously proposed, but is due to greater insulin resistance, probably secondary to higher levels of counterregulatory hormones and cytokines and the use of medications, although beta cell dysfunction secondary to prolonged hyperglycemia, inflammation, and/or low beta-cell reserve cannot be ruled out.”
Both COVID-19 and dysglycemia were found to be independent risk factors for mortality. Notably, univariate analysis also found that study participants with SARS unrelated to COVID-19 had a 1.5 times higher likelihood of mortality (odds ratio, 2.528; 95% CI, 1.642–3.892; P <.001).
Study limitations include the observational design, subjectively determined obesity information, and possible undiagnosed diabetes.
“Patients with severe acute respiratory syndrome due to COVID-19 had higher mortality and more frequent dysglycemia than patients with severe acute respiratory syndrome due to other causes,” investigators concluded. They added “The dysglycemias were not independently associated with COVID-19, but rather related to disease severity, inflammatory markers, and the use of glucocorticoids.”